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Everyone has to die of something

Certainly everyone has to die of something but

death does not need to be slow death does not need to be painful death does not need to be premature

Everyone has to die of something

Most non-communicable disease do not result in sudden death Prevention and control helps people to live longer and healthier lives

Raj K. Subedi. BPH, MPH

Non communicable Disease

Noncommunicable Disease
Diseases Present at Birth
Genetic Disorder- one in which the body does not develop or function normally because of an inherited problem Birth Defect- disorders of the developing and newborn baby, causes unknown In most cases there are no cure for either genetic disorders or birth defects

A Non communicable Disease is a disease that is not spread through contact.

Are caused by how people live, conditions they are born with, or environmental hazards. Are not spread by contact because most are not caused by germs

Diseases Resulting from Lifestyle Behaviors

Risk Factors are certain characteristics that increase a persons chances of developing the disease. Many diseases are the direct or indirect result of harmful lifestyle behaviors. Healthful lifestyle behaviors, on the other hand, can help prevent or control certain diseases and disorders.


Non-Communicable Disease

Heart disease

Diseases Caused by the Environment

Many diseases are caused by hazards in the environment Examples of harmful substances that may be present in the environment: Fumes for chemicals, second hand smoke, radon, asbestos

There are many forms of heart disease Coronary heart disease is the leading cause of death globally It is caused by disease of the blood vessels of the heart, usually as part of the process which affects blood vessels more generally



Stroke is a disease of the brain caused by interference to the blood supply Stroke and heart disease are the main cardiovascular disease

Cancer describes a range of disease in which abnormal cells proliferate and spread out of control. Tobacco is the main preventable cause of cancer Excessive alcohol use include cancer of the liver, mouth, throat and so on


Chronic respiratory diseases


Chronic obstructive pulmonary disease (COPD) and Asthma

COPD is caused by airflow limitation that is not fully reversible Asthma is caused by reversible obstruction of the airways Risk factors for COPD and asthma air pollution, tobacco consumption Psychological and genetic factors also play a role

Diabetes is characterized by raised blood glucose (sugar) levels This results from a lack of the hormone insulin, which controls blood glucose levels, and/or an inability of the bodys tissues to respond properly to insulin (a state called insulin resistance. The most common type of diabetes is type 2, which accounts for about 90% of all diabetes and is largely the result of excessive weight and physical inactivity

The problem

The problem

80% of chronic disease deaths occur in low and middle income countries The threat is growing,
the number of people, families, and communities afflicted is increasing This growing threat is an under-appreciated cause of poverty and hinders the economic development of many countries

The problem has serious impact

Major adverse effects on the quality of life of affected individuals Premature death Creates large adverse and underappreciated economic effects on families, communities and societies in general

It has been estimated that China will forego US$ 558 billion in national income over the next 10 years as a result of premature deaths caused by heart diseases, stroke and diabetes
80% of premature heart diseases, stroke and diabetes can be prevented


The risk factors

The health impact of the main risk factors

Each year at least; 4.9 million people die as a result of tobacco use 2.6 million people die as a result of being overweight or obese 1.9 million people die as a result of physical inactivity 2.7 million people die as a result of low fruit and vegetable consumptions 4.4 million people die as a result of raised total cholesterol levels 7.1 million people die as a result of raised blood pressure

The risk factors that explains the vast majority of non-communicable disease deaths at all ages, in men and women and in all parts of the world. They include:
Unhealthy diet physical inactivity tobacco use

Burden of disease (DALY)


Disability adjusted life year which combines the number of years of healthy life lost to premature death with time spent in less than full health (YLL+YLD)

39% by communicable diseases, maternal and perinatal conditions and nutritional deficiencies combined 13% injuries 10% cardiovascular diseases 5% cancer 4% COPD 1% diabetes 28% other chronic diseases


Distribution of deaths in the world by sex, 2004

Preventing chronic disease, WHO, 2005

Distribution of deaths by leading cause groups, males and females, world, 2004

Leading Causes of Mortality and Burden of Disease world, 2004 Mortality

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

% 12.2 9.7 7.1 5.1 3.7 3.5 2.5 2.2 2.0

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Lower respiratory infections Diarrhoeal diseases Depression Ischaemic heart disease HIV/AIDS Cerebrovascular disease

% 6.2 4.8 4.3 4.1 3.8 3.1 2.7 2.7 2.7

Ischaemic heart disease Cerebrovascular disease Lower respiratory infections COPD Diarrhoeal diseases HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers 2.3 Road traffic accidents Prematurity, low birth weight

Prematurity, low birth weight 2.9 Birth asphyxia, birth trauma Road traffic accidents Neonatal infections and other


Burden of disease by broad cause group and region, 2004

Burden of injuries (DALYs) by external cause, sex and WHO region, 2004

The 10 leading causes of death by broad income group, 2004

Mortality rates among men and women aged 1559 years, region and cause-of-death group, 2004


2. Adult mortality rates by major cause group and region, 2004

High income Western Pacific Americas Eastern Mediterranean South East Asia Europe Africa 0 2 4 6 8 10 Death rate per 1000 adults aged 1559 years 12
Cardiovascular diseases Cancers Other noncommunicable diseases Injuries HIVAIDS Other infectious and parasitic diseases Maternal and nutritional conditions

3. Leading causes of disease burden for women aged 1544 years, high-income countries, and lowand middle-income countries, 2004

4. Major causes of disease burden for women aged 1559 years, highincome countries, and low- and middle-income countries by WHO region, 2004

Projections for 2030

1. Global projections for selected causes 2. Projection by cause and income 3. Projection for leading causes of burden of disease


1. Global projections for selected causes, 2004 to 2030


2. Projected deaths by cause and income, 2004 to 2030

30 25
Intentional injuries Other unintentional Road traffic accidents Other NCD Cancers

Cancers Ischaemic HD Stroke

Deaths (millions)

10 Deaths (millions)

20 15 10 5 0
2004 2015 2030 2004 2015 2030 2004 2015 2030

Acute respiratory infections Road traffic accidents Perinatal HIV/AIDS TB Malaria

2005 2010 2015 2020 2025 2030
Updated from Mathers and Loncar, PLoS Medicine, 2006

CVD Mat//peri/nutritional Other infectious HIV, TB, malaria

0 2000

High income

Middle income

Low income

3. Ten leading causes of burden of disease, world, 2004 and 2030

Causes of non-communicable diseases

Underlying socioeconomic, cultural, political and environmental factors Globalization Urbanization Population aging Common modifiable risk factors Unhealthy diet Physical inactivity Tobacco use Non-modifiable risk factors Age Heredity Intermediate risk factors Main noncommunicable disease Heart disease Stroke Cancer Chronic respiratory diseases Diabetes

Raised blood pressure Raised blood glucose Abnormal blood lipids Overweight/obe sity


Situation in Nepal and SEAR


Public Health and the Environment Geneva 2009

Major reported NCDs, Nepal

Death due to NCDs, Nepal

Cancer, CVD, Neuropsychiatric disorders, Diabetes mellitus, and Hypertension Data from the private sector was not included in the report. The major bias in aggregated data is caused by under and mis-reporting of events due to poor accessibility of health care services and difficulties in establishing diagnosis. There is no standardized reporting format for NCDs. Most deaths occur outside hospitals.

Out of estimated 254 859 deaths in Nepal in 1997/1998, only 68 552 events were analyzed. 4% death due to COPD 1.9% death due heart diseases 0.8% death due to cancer


Hospital survey

Hospital survey (Bir Hospital)

A hospital survey carried out in Kathmandu Valley showed that

cancer contributed to 3% of admissions. The leading sites of cancer were lung 8.19%, breast 6.07%, and cervix uteri 6.35%.

Different pattern of admissions was observed in Bir Hospital (a tertiary hospital).

Stroke was ranked as number one, COPD number two, Poisoning number three, Renal failure number four, Cancer number five, Diabetes mellitus number six, Hypertension number seven, and diabetic nephropathy number eight.

NCDs: available information

Cardiovascular diseases

No studies on CVD, examining the problem in the national context, have been conducted so far. However, based on available information, it was estimated that the prevalence of CVD is
5.6% in the mountain area, 1.5% in the hills, and 5% in the Terai.

Cardiovascular diseases are major and growing contributors to mortality and disability in South Asia, Nepal as well. The cardiovascular disease profile in the region shows the presence of emerging and advancing diseases (such as coronary heart disease and stroke) and established but receding diseases (such as rheumatic heart disease and hypertension (which is also a risk factor for stroke and coronary heart disease)).

The prevalence of hypertension among adults is estimated to be 5-20% and that of diabetes mellitus is 15% in urban and 2% in rural areas (in the age group 15+ years).



Cardiovascular diseases


Stroke is a major cause of mortality and also amounts to a large proportion of DALYs (disability adjusted life years) lost. Hypertension has been widely studied in community surveys, though nationally representative estimates are not available The prevalence of hypertension in adults was estimated to be 23% and 18% in urban and rural areas respectively

Hypertension was positively associated with higher socioeconomic status in both urban and rural areas. Some surveys of risk factors conducted across country have shown high and rising rates of overweight, central obesity, diabetes, and high blood pressure in urban populations. The socioeconomic gradient in cardiovascular diseases and related risk factor distributions among population groups are also changing. Tobacco consumption is now universally more common among the lower socioeconomic groups.

Diabetes mellitus

Prevalence of diabetes in South Asia, 2000 and 2025 projected in 1998) Values are percentages (number of people with diabetes, 000s)

The prevalence of diabetes and its adverse health effects has risen more rapidly in South Asia than in any other large region of the world In Nepal, it has been reported as 3% in rural and 15% in urban

2000 2025 Bangladesh 2.2 (1 564) 3.1 (4 032) Bhutan 2.1 (19) 2.3 (39) India 4.0 (22 878) 6.0 (57 243) Maldives 2.5 (3.2) 3.0 (9.2) Nepal 2.2 (263) 2.6 (638) Pakistan 7.1 (5 310) 8.7 (14 523) Sri Lanka 2.6 (318) 3.5 (617)




Chronic respiratory diseases

Cancer is regarded as one of the major noncommunicable diseases affecting South Asia, accounting for a large proportion of the DALYs lost in this area. The most common cancers in males are of lung and oropharynx and in females are of the cervix, uterus, and breast.

Chronic obstructive airway diseases (emphysema and chronic bronchitis) and asthma, resulting from indoor and outdoor air pollution, account for a large proportion of the burden of chronic respiratory diseases. Morbidity from respiratory diseases accounts for 65 million cases and about 580 000 deaths in India.

Estimates of age standardised rates in SEA region range from 99.0 to 129.6 per 100 000 in males and 104.4 to 154.3 per 100 000 in females.

Problems encountered in investigation of non-communicable diseases in Nepal

Problems encountered in reducing burden of NCDs (in Nepal)

Less public awareness Less government spending and priority Lack of strict plans, policies Not sufficient database to support information Multiple risk factors No or less clinical features Lack of diagnostic tools and techniques Donors interest High burden of communicable diseases Takes long time to develop the disease High population mobility

Increasing urbanization Changing diet pattern, sedentary lifestyle Unequal food distribution High income gradient Lack of data, labs, manpower, budget Inadequate political commitment Socio cultural practices and peoples resistance to change



Effect of Non-communicable diseases

Preventing NCDs

medical costs as prevention, diagnosis and treatment of disease, and costs related to ambulances, patient care, medication, rehabilitation, and other health services. (direct cost) losses due to foregone productivity caused by morbidity or premature death. (indirect cost) psychological aspects as pain, disability and suffering caused by chronic diseases (intangible cost)

WHO proposed a goal in 2005 to reduce deaths from chronic diseases by an additionally 2 % every year from 2005 to 2015 This would avert around 36 million deaths worldwide with 28 million of them averted in lowand middle-income countries.

preventing non-communicable diseases.pdf